Riesgo de accidente cerebrovascular en pacientes con aterosclerosis carotídea asintomática: ¿se debe tratar médicamente o quirúrgicamente?
DOI:
https://doi.org/10.24265/horizmed.2023.v23n3.11Palabras clave:
Accidente Cerebrovascular, Riesgo, Enfermedades de las Arterias Carótidas , Procedimientos Quirúrgicos Operativos, TerapéuticaResumen
Los desórdenes cerebrovasculares siguen siendo la primera causa de morbilidad y mortalidad neurológica en el mundo, representando una de las entidades patológicas que genera mayor carga de enfermedad a nivel global. La aterosclerosis,
o estenosis carotídea, es un potencial factor de riesgo para el ictus isquémico. La identificación y seguimiento estricto de esta condición son esenciales en la prevención secundaria de complicaciones a través de la atención primaria y
el manejo especializado del riesgo cardiometabólico. No obstante, dependiendo de este riesgo y/o la presencia de sintomatología, es necesario realizar un manejo definitivo. Actualmente, existe controversia sobre si es mejor tratar la estenosis carotídea asintomática, ya sea médica o quirúrgicamente. Teniendo en cuenta la relevancia de esta entidad, el
objetivo de esta revisión consiste en analizar la evidencia reciente sobre el riesgo de ictus isquémico en la aterosclerosis carotídea asintomática en adultos, y el potencial beneficio del manejo quirúrgico vs. farmacológico de esta condición.
Para esto, se llevó a cabo una búsqueda bibliográfica en las bases de datos PubMed, ScienceDirect, Web of Science y MEDLINE, hasta el año 2023. Se evidenció que el riesgo de ictus asociado a estenosis carotídea asintomática es significativo (>10 %, aproximadamente), incluso en aquellos con terapia antiplaquetaria e hipolipemiante activa. En aquellos con manejo médico, la supervivencia a cinco años es alrededor del 80 %. Sin embargo, la progresión de la estenosis sucede en promedio en más del 60 % de los casos, y es significativa. Por el contrario, el stent carotídeo y la endarterectomía son intervenciones resolutivas. Pero existe un riesgo mayor comparado con la terapia médica, el cual se atribuye al periodo
peri- y posoperatorio, así como a 30 días de aparición o recurrencia del ictus, infarto agudo de miocardio o muerte por cualquier causa; aunque el uso de la endarterectomía ha demostrado beneficios superiores a largo plazo en cuanto a estos mismos desenlaces. Entonces, la evidencia es heterogénea en cuanto a la superioridad del tratamiento quirúrgico
comparado con la terapia farmacológica en el manejo de la aterosclerosis o estenosis carotídea asintomática. Sin embargo, parece ser que el manejo quirúrgico, específicamente la endarterectomía, podría impactar significativamente sobre la aparición o recurrencia del ictus ipsilateral y muerte a largo plazo, pero con resultados controversiales peri- y
postoperatorios.
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and subarachnoid haemorrhage: A systematic analysis of the Global
Burden of Disease Study 2017. Neuroepidemiology [Internet].
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Zhang T, Yin X, Zhang Y, Chen H, Man J, Li Y, et al. Global trends in
mortality and burden of stroke attributable to lead exposure from
to 2019. Front Cardiovasc Med [Internet]. 2022;9:870747.
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Handb Clin Neurol [Internet]. 2016;138:239-61.
Pan American Health Organization. Cardiovascular disease burden
[Internet]. Disponible en: https://www.paho.org/en/enlace/
cardiovascular-disease-burden
World Health Organization. Cerebrovascular disease [Internet].
Disponible en: https://platform.who.int/mortality/themes/themedetails/topics/indicator-groups/indicator-group-details/MDB/
cerebrovascular-disease
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associations between visceral adiposity index and cardiovascular
and cerebrovascular diseases: Results from the NHANES (1999-2018).
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diseases in the UK [Internet]. University of Oxford; 2009. Disponible
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studies-28/the-economic-burden-of-cerebrovascular-diseases-inthe-uk-2
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Derechos de autor 2023 Roberth Nixon Moreno Muñoz, Richard Adrián Vergara Trujillo, German Andrés Guevara Lizarazo, Patrick Junior Brett Cano, Dalila Andrea León Cuervo, Adriana Marcela Puerta Lidueñas, Mariana Sarmiento Figueroa, Michael Ortega Sierra
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Todos los artículos aceptados y publicados en la Revista Horizonte Médico se distribuyen gratuitamente bajo los términos de la licencia Creative Commons Attribution 4.0 International (CC BY 4.0).
